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Diabetes Meds Flashcards

1
Q

1st line tx for DM II

A

Metformin

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2
Q

Metformin mechanism

A

decrease Liver production of glucose (no effect on beta cells)

Added benefits:

  • weight loss
  • decrease triglycerides
  • dec CVD risk
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3
Q

SE of GI complaints, metallic taste, Vit B12 def, Lactic acidosis

A

Metformin

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4
Q

Sulfa meds

A

“Gl____”

2nd gen (used more often)

  • Glyburide
  • Glipizide
  • Glimepiride

1st gen

  • Tolbutamide
  • Chlorpropamide
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5
Q

Mechanism of sulfa

A

Stimulate beta cell Insulin release

similar glycemic efficacy as Metformin

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6
Q

SE of Sulfa

A

HYPOGLYCEMIA risk

Weight gain

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7
Q

Chlorpropamide (a 1st gen Sulfa med) has unique SE

A

Hyponatremia (low sodium)

Disulfuram like rxn (do not drink alcohol)

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8
Q

Meglitinides

A

“___glinide”
Repaglinide
Nateglinide

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9
Q

Repaglinide
Nateglinide

mechanism

A

Stimulate beta cell Insulin release

more so post prandial

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10
Q

SE of Metiglinides are same as sulfa

A

Hypoglycemia

Weight gain

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11
Q

Repaglinide is a good option for

A

pts with CKD

nice to the Kidneys

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12
Q

TZDs

A

Pioglitazone
Rosiglitazone

increase Insulin sensitivity at PERIPHERAL sites

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13
Q

SE of TZD

A

EDEMA
Fluid retention
BAD for CHF
Increased fractures

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14
Q

do NOT use TZD with

A 
Type I DM
HF
Hx bladder CA
High risk fractures
Pregnancy
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15
Q

DPP-4 inhib

A

“gliptins”

Sitagliptin
Linagliptin
Saxagliptin

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16
Q

Sitagliptin
Linagliptin
Saxagliptin

are all

A

DPP-4

“gliptins”

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17
Q

Mechanism of “gliptins” (DPP-4 inhibitors)

A

Slow degradation of GLP-1 allowing that enzyme to do its job

leading to: increased Insulin sens, dec Glucagon secretion, decrease gastric emptying

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18
Q

SE of “gliptins” (DPP-4inibitors)

A 
Acute Pancreatitis
HA
Hepatitis
Skin change
Joint pain
Renal dysfx
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19
Q

Saxagliptin has a bad rep for being linked to

A

increased risk of HF (heart failure)

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20
Q

GLP-1 RA

A

Liraglutide
Exanatide
Dulaglutide

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21
Q

Lira
Exana
Dula

A

GLP-1 RA

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22
Q

Mechanism of GLP-1 RA

A

Mimics Incretin

  • increase Insulin sensitivity
  • decrease Glucagon release
  • delay gastric emptying

Added benefits

  • weight loss
  • decrease CVD events
  • no risk of Hypoglycemia if used alone
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23
Q

CONTRA to GLP-1RA

Lira
Exana
Dula

A

Hx of Gastroparesis
Hx of Pancreatitis
Hx of THYROID CA
Hx of MEN syndrome

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24
Q

SGLT-2 Inhibitors

A

“flozins”

Empagaflozin
Canagliflozin
Dapagiflozin

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25
SGLT-2 Inhibitors
Proximal tubule | Increase glucose excretion weak when used alone, thus often used in COMBO with: Pioglitazone, Sitagliptin, or Insulin
26
Benefit of SGLT-2 Inhibitors
Decrease CVD events Lower BP Weight loss
27
CONTRA to using SGLT "flozins"
Type I DM | or Type II DM if GFR <60 (need a good working kidney to use these)
28
Canagliflozin has a bad rep for being linked to
Amputation risk!!!
29
Caution in using SGLT2 inh "flozins" with other meds that can cause Dehydration
NSAIDs ACE-I ARBs Diuretics
30
SE of SGLT 2 Inhib "flozins"
``` N/v Thirst AKI (acute kidney injury) Bone fracture UTI Yeast infection ```
31
Acarbose | Miglitol
Alpha glucosidase inhibitors | delay intestinal glucose absorption less potent than Metformin and Sulfa
32
a-glucosidase inhibitors - Acarbose - Miglitol SE
GI, flatulence, diarrhea, Hepatitis safe in pts with Kidney issues
33
Two best meds for MACE prevention
Empagaflozin (SGLT) | Liraglutide (GLP)
34
Lispro | Aspart
Rapid acting insulin
35
Lispro, AKA
HUmalog
36
Aspart, AKA
Novolog
37
NPH | Lente
Intermediate insulin
38
Detemir | Glargine
Long acting insulin
39
Decrease Cardiovascular events
Liraglutide | Empagaflozin
40
Linked to amputation
Canagaflozin
41
Linked to Heart Failure
Saxagliptin
42
Nice to kidneys
Acarbose, Miglitol | Repaglinide
43
Weight loss
GLP-RA "glutides" Metformin SLGT "flozins"
44
Weight loss
Metformin Empagaflozin, Canagaflozin, Dapagaflozin Liraglutide, Exanatide, Dulaglutide
45
"glutides" and "flozins" and Metformin are special why:
Aid in Weight loss
46
Aspart "Novolog" and Lispro "Humalog"
Fast acting insulin
47
Detemir and Glargine
Long acting insulin
48
Glyburide, Glipizide, Glimepiride
Sulfa diabetes drugs
49
Bactrim
is a SULFA drug Trimethoprim/Sulfamethoxazole
50
What do you need to avoid if pt has Sulfa allergy? Med names that may be sneaky
Bactrim Glyburide Glipizide Glimepiride
51
Diagnosing Diabetes all symbols are Greater than or Equal to
Fasting 126 A1C 6.5% 2 hour test 200 Classic sx + Random 200
52
Diagnose DM with FASTING glucose
126
53
Diagnose DM with A1C
6.5%
54
Diagnose DM with Random glucose
200 + need Classic sx of Hyperglycemia
55
Diagnose DM with 2 hour test
200
56
If ASCVD risk is >20%
Need High intensity Statin therapy
57
Why are Diabetes and ASCVD together so important to keep an eye on?
Those with Diabetes are 2x as likely to die of STROKE or HEART ATTACK than those w/o
58
MACE
Major Adverse Cardiovascular Event
59
Meds that help prevent MACE
Flozins (SLGT) | Glutides (GLP-RA)
60
If pt has ASCVD (Atherosclerotic Cardiovascular Dz) AND Diabetes, what should the be on other than the Diabetes meds?
ASA (anti-clot) | Statin
61
Weight loss
Glutides | Flozins
62
Safe for HF or CKD
Flozins
63
If pt needs a cheap Med
TZD | Sulfas (Glyburide, Glipizide, Glimebiride)
64
What to reach for first in DMII meds?
Metformin Glutides (GLPra) Flozins (SLGT)
65
DM II meds that you generally avoid d/t SE unless pt needs cheap med
Sulfa (Glyburide, Glipizide, Glimepiride) TZD (Pioglitazone, Rosiglitazone)
66
TZD risky business
Edema, fluid retention CHF Inc fractures Dangerous w Type 1 DM, Bladder CA, High risk fx, Prego
67
Good choice for Dual therapy in DM mgmt
Metformin + Glutide (GLPra) Flozin (SGLT) Gliptin (DPP)
68
1st picks after Metformin
Glutides | Flozins
69
Glutides and Flozins are 1st picks after Metformin, but what do we need to be aware of with Glutides (GLPra)?
Glutides are a/w increased risk of Thyroid C-cell Tumor Risk
70
Thyroid C cell tumor risk
Glutides Liraglutide, Exanatide, Dulaglutide
71
With Flozins, what do you need to keep in mind?
Making the kidney tubules work harder by excreting more and more glucose MONITOR GFR!!! Have to stop if GFR drops below 30
72
Flozins (SGLT) have a FDA warning for
Quiet DKA
73
Canagaflozin (SGLT) is a/w
INCREASED AMPUTATION RISK esp if pt has DM and ASCVD
74
Eventually, someone with Type II DM might have to start using Insulin if other meds aren't working if these values are reached or exceeded
A1C 10% | Glucose 300
75
Insulin Glargine, aka
Lantus long acting
76
Insulin Detemir and Degludec are
Long acting
77
Insulin NPH, aka
Humilin N Novolin N Intermediate acting
78
Long acting insulin timeline
reaches blood several hours later, but works for 24 hours
79
Intmdt acting insulin NPH, Humilin, Novilin
Starts working 2-4 hours later, peaks 4-12, then stops working 12-18 hours later
80
Regular/SHORT acting insulin
Reaches blood in 30 min Peaks 2-3 hrs later Works for 3-6 hours
81
TImeline for Regular/SHORT acting insulin that is used often
Reach 30 min Peak 2-3 hr Last 3-6 hrs
82
Regular/short acting is DIFFERENT from
RAPID acting
83
Rapid acting insulin, aka
"mealtime" | "Correction"
84
Rapid acting insulin is used often "meal tie" correction"
Lispro (humalog) Aspart (novolog) Glulisine (apidra)
85
Lispro, aka
Humalog Rapid acting
86
Aspart, aka
Novolog Rapid acting
87
Timeline for Rapid acting Insulin Lispro "humalog" Aspart "Novolog"
"mealtime" "correction" Starts working 15 min Peak 1 hr Continue working for 2-4 hours
88
Good candidate for Premixed Insulin
If pt is stable on insulin and diet is same everyday Poor adherence to basal-bolus regimen
89
What is the risk with Premixed insulin
Hypoglycemia
90
Calculating Basal dose TDD= total daily dose
0.5 x 1 unit x Weight (kg)
91
Insulin amount should be split between
Basal and Bolus

Clinical Prep (41 decks)

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